Epidemiology
Usually 50-60 years old
Aetiology
1° uncommon
2° most common
- AVN
- trauma
- cuff arthropathy (Neer)
- instability
Pathology
Cuff & biceps intact as rule
- rare to have OA and rotator cuff pathology
Inferior osteophytes
- beard
Retroversion of glenoid
- posterior wear
Posterior subluxation not uncommon
Tight anterior capsule & subscapularis
- limitation of ER
Post traumatic
- always soft tissue contracture
- limitation of ER
- CH ligament and rotator interval contracted
- malunion of tuberosities leads to impingement and offset of normal cuff action
- non-union results in extensive shortening of cuff
- scarring about axillary nerve
Signs
Global painful restriction of range of movement
- due to incongruity of joint surfaces
- crepitus
- limitation of ER
DDx Limitation ER
Frozen Shoulder
Chronic posterior dislocation
Arthrodesis = Lack of ER
Post septic arthritis
X-ray
Typical changes of OA
1. Teardrop osteophytes on inferior head & glenoid
2. Osteochondral loose bodies
DDx
- cuff arthopathy - proximal migration of head & subacromial sclerosis
Arthroscopy
Management
Non-operative
Education & Reassurance
- Analgesia
- NSAID
- Physio
ROM
Strengthening
Operative
1. Arthroscopic Debridement
Concept
- if patient has acromial spur and acromioclavicular pathology
- may benefit from debridement
- concept of limited goals
Technique
A. Glenohumeral joint
- deal with biceps tendon pathology if present (tenotomy / tenodesis)
- synovectomy
B. Subacromial space
- acromioplasty
- CA ligament left intact
- ACJ resection
C. Removal beard osteophyte
- additional option
- may improve ROM
- risk of axillary nerve injury
2. Arthrodesis
Indication
- may be considered in young active patient
Issues
- good pain relief but limitation movement
- difficult to perform
- rarely done in the modern age
3. Excision Arthroplasty
Issue
- good pain relief but main problem is flail arm
4. Arthroplasty
Options
- hemiarthroplasty (young patient or insufficient glenoid bone stock)
- TSR